1) Hospital post-mortem
A hospital post-mortem is usually asked for by the patient's doctor.
Either to provide information about the illness or cause of death or to advance medical research.
Hospital post-mortems can only be carried out if consent has been given from the next of kin - a relative may ask for a post-mortem to find out more about the cause of death. The next of kin would need to request this by approaching the clinical team who cared for their relative.
A post mortem can also help doctors to understand illnesses and may also contribute to the development of new ways of treating patients with similar problems.
Post mortems can be limited to certain areas of the body, such as the head, chest, or abdomen, and this would be discussed with the next of kin when asked for consent. Only the specific organs or tissue for which consent was provided, can be removed for examination.
The Human Tissue Authority recommends that the next of kin should be given 24 hours to consider their decision about the post-mortem.
2) Coroner’s post-mortem
In England, Wales, and Northern Ireland, a ‘medico-legal’ (involving both legal and medical aspects) post-mortem examination can be instructed by a coroner in certain circumstances. This is called a ‘coroner’s post-mortem’ and is the most commonly performed type of post mortem. It is carried out under the authority of a local coroner to find out how someone has died. Coroners are usually lawyers or doctors with a minimum of five years' experience. The police or a doctor may report the death to a coroner if the:
• cause of death is unknown • person who died was not seen by a medical practitioner during their final illness • person who died wasn’t seen by the doctor who signed the medical certificate within 14 days before death or after they died • death was violent or unnatural • death was sudden and unexplained • death occurred during an operation • death occurred before the person came out of an anesthetic • medical certificate isn’t available • the medical certificate suggests the death may have been caused by an industrial disease or industrial poisoning. In this instance, the next of kin is not asked for consent however the coroner must tell the next of kin when and where the post-mortem will take place if asked. The next of kin also have the right to be represented at the post-mortem by a medical practitioner should as a GP. The pathologist who undertakes the post mortem is chosen by the coroner to establish the cause of death on the 'balance of probability'. This means the cause of death given in the post-mortem report is that which the pathologist feels is the most likely, given the information that is available to him or her at the time of writing the report, and taking into account what they found out during the post mortem. The cause of death given by the pathologist may be altered by the coroner at a subsequent inquest if more information comes to light. Once a post-mortem has been carried out and the relevant paperwork is completed, the body will be released and returned to the undertaker selected by the family. The coroner must release the body to the family as soon as possible. In the event that the body cannot be released for more than 28 days, the coroner will inform the family. In some circumstances, a coroner may open an inquest into the death of an individual after a post-mortem examination.